IMAGE  EVALUATION 
TEST  TARGET  (MT-3) 


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144  IIM    IIIII25 


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Photographic 

Sciences 
Corporation 


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23  WEST  MAIN  STREET 

WEBSTER,  N.Y.  14580 

(716)  872-4503 


K"^ 


iV 


CIHM/ICMH 

Microfiche 

Series. 


CIHM/ICMH 
Collection  de 
microfiches. 


Canadian  Institute  for  Historical  Microreproductions  institut  Canadian  de  microreproductions  historiques 

1980 


Technical  and  Bibliographic  Notes/Notes  techniques  et  bibliographiques 


Tl 
tc 


The  Institute  has  attempted  to  obtain  the  best 
original  copy  available  for  filming.  Features  of  this 
copy  which  may  be  bibliographically  unique, 
which  may  alter  any  of  the  images  in  the 
reproduction,  or  which  may  significantly  change 
the  usual  method  of  filming,  are  checked  below. 


rVc 


V 


n 


n 

n 
n 

n 


Coloured  covers/ 
Couverture  de  couleur 


I      I    Covers  damaged/ 


Couverture  endommagie 


Covers  restored  and/or  laminated/ 
Couverture  restaur^e  et/ou  pellicul6e 


□   Cover  title  missing/ 
Le 


titre  de  couverture  manque 


Coloured  maps/ 

Cartes  giographiques  en  couleur 


Coloured  ink  (i.e.  other  than  blue  or  black)/ 
Encre  de  couleur  (i.e.  autre  que  bieue  ou  noire) 


Coloured  plates  and/or  illustrations/ 
Planches  et/ou  illustrations  en  couleur 


Bound  with  other  material/ 
Reli6  avec  d'autres  documents 

Tight  binding  may  cause  shadows  or  distortion 
along  interior  margin/ 

La  reliure  serr6e  peut  causer  de  I'ombre  ou  de  la 
distortion  le  long  de  la  marge  intdrieure 

Blank  leaves  added  during  restoration  may 
appear  within  the  text.  Whenever  possible,  these 
have  been  omitted  from  filming/ 
II  se  peut  que  certaines  pages  blanches  ajout6es 
lors  d'une  restauration  apparaissent  dans  le  texte, 
mais,  lorsque  cela  6tait  possible,  ces  pages  n'ont 
pas  6t6  film6es. 


L'Institut  a  microfilm^  le  meilleur  exemplaire 
qu'il  lui  a  6t6  possible  de  se  procurer.  Les  details 
de  cet  exemplaire  qui  sont  peut-dtre  uniques  du 
point  de  vue  bibliographique,  qui  peuvent  modifier 
une  image  reproduite,  ou  qui  peuvent  exiger  une 
modification  dans  la  mithode  normale  de  filmage 
sont  indiquds  ci-dessous. 

□    Coloured  pages/ 
Pages  de  couleur 

|~n/Pages  damaged/ 
I J    Pages  endommag6es 

r~~l/ Pages  restored  and/or  laminated/ 
I      I    Pages  restaurdes  et/ou  pelliculdes 

I     r/Pages  discoloured,  stained  or  foxed/ 
LkJ    Pages  d6colordes,  tachet^es  ou  piqudes 


\A 


Pages  detached/ 
Pages  d6tach6es 


I      I    Showthrough/ 


Transparence 


□    Quality  of  print  varies/ 
Quality  inigale  de  I'impression' 

I      I    Includes  supplementary  material/ 


D 
D 


Comprend  du  materiel  supplementatre 

Only  edition  available/ 
Seule  Edition  disponible 

Pages  wholly  or  partially  obscured  by  errata 
slips,  tissues,  etc.,  have  been  refilmed  to 
ensure  the  best  possible  image/ 
Les  pages  totalement  ou  partiellement 
obscurcies  par  un  feuillet  d'errata,  une  pelure, 
etc.,  ont  6t6  filmies  d  nouveau  de  fapon  d 
obtenir  la  meilleure  image  possible. 


Tl 

P 
o 
fi 


0 
b 
tl 
si 
o 
fi 
si 
o 


T 
si 
T 
v\ 

IV 
di 
ei 
b( 
ri 
rj 
n 


D 


Additional  comments:/ 
Commentaires  supplimentaires; 


10X 


This  item  is  filmed  at  the  reduction  ratio  checked  below/ 

Ce  document  est  filmi  au  taux  de  reduction  indiqu6  ci-dessous. 

14X  18X  22X 


26X 


30X 


12X 


16X 


7 


20X 


24X 


28X 


32X 


The  copy  filmed  here  has  been  reproduced  thanks 
to  the  generosity  of: 

National  Library  of  Canada 


L'exemplaire  film6  fut  reproduit  grdce  d  la 
g6n6rosit6  de: 

Bibliothdque  nationale  du  Canada 


The  images  appearing  here  are  t'.ie  best  quality 
possible  considering  the  condition  and  legibility 
of  the  original  copy  and  in  keeping  with  the 
filming  contract  specifications. 


Les  images  suivantes  ont  6t6  reproduites  avec  le 
plus  grand  soin,  compte  tenu  de  la  condition  et 
de  la  nettetd  de  l'exemplaire  film6,  et  en 
conformity  avec  les  conditions  du  contrat  de 
filmage. 


Original  copies  in  printed  paper  covers  are  filmed 
beginning  with  the  front  cover  and  ending  on 
the  last  page  with  a  printed  or  illustrated  impres- 
sion, or  the  back  cover  when  appropriate.  All 
other  original  copies  are  filmed  beginning  on  the 
first  page  with  a  printed  or  illustrated  impres- 
sion, and  ending  on  the  last  page  with  a  printed 
or  illustrated  impression. 


les  exemplaires  originaux  dont  la  couverture  en 
papier  est  imprimde  sont  filmds  en  commenpant 
par  le  premier  plat  et  en  terminant  soit  par  la 
dernidre  page  qui  comporte  une  empreinte 
d'impression  ou  d'illustration,  soit  par  le  second 
plat,  selon  le  cas.  Tous  les  autres  exemplaires 
originaux  sont  filmds  en  commengant  par  la 
premidre  page  qui  comporte  une  empreinte 
d'impression  ou  d'illustration  et  en  terminant  par 
la  dernidre  page  qui  comporte  une  telle 
empreinte. 


The  last  recorded  frame  on  each  microfiche 
shall  contain  the  symbol  -^  (meaning  "CON- 
TINUED"), or  the  symbol  V  (meaning  "END"), 
whichever  applies. 


Un  des  symboles  suivants  apparaltra  sur  la 
dernidre  image  de  cheque  microfiche,  selon  le 
cas:  le  symbols  — ►  signifie  "A  SUIVRE",  le 
symbole  V  signifie  "FIN". 


Maps,  plates,  charts,  etc.,  may  be  filmed  at 
different  reduction  ratios.  Those  too  large  to  be 
entirely  included  in  one  exposure  are  filmed 
beginning  in  the  upper  left  hand  corner,  left  to 
right  and  top  to  bottom,  as  many  frames  as 
required.  The  following  diagrams  illustrate  the 
method: 


Les  cartes,  planches,  tableaux,  etc.,  peuvent  dtre 
film6s  d  des  taux  de  reduction  diffdrents. 
Lorsque  le  document  est  trop  grand  pour  ^tre 
reproduit  en  un  seul  cliche,  il  est  film6  d  partir 
de  Tangle  sup6rieur  gauche,  de  gauche  d  droite, 
et  de  haut  en  bas,  en  prenant  le  nombre 
d'images  nicessaire.  Les  diagrammss  suivants 
illustrent  la  m6thode. 


1 

2 

3 

1 

2 

3 

4 

5 

6 

r*," 


?/-  1. 


Eit!  F«  or  mi  m  mewisi 


'  i 


PAPER    PRESENTED  'AT    THE    ANNUAL    MEETING   OF 
THE   NEW  YOflk   STATE  MEDICAL  ASSO- 
CIATION,  OCTOBER   II,    1893 


By  Sir  JAMES  GRANT,  M.  D.,  K.  G.  M.  G. 


0/  Omm,  Canada. 


i^tpfnOtd  fi-otn  the  Transactions  of  the  New   York  State  Medieai 
Association  for  1893] 


CONCORD,  N.   H. 

»  E  P  U  B  L I  CAN    PRESS    ASS^I  **ION 
•893 


li  iif if  I  r  I  ti|iii  I'll  •   I  li  II  11 1  ■  1;  r"  I v Ti  1 1  "iMiii  in '  ],i  w|"iTl  II  "^  Ti  III ;-)  vi ,  iVli|i'iijiu>-  ii'i'l' ' '  "'";""?■  V'  jnglT  i  >  i  ji  iji  ii '  lii' jThVn'^^  ifn'ii  ni '  J^nCm  '  ^'  >■"  v'  V?^^ 


"-'■^i 

?'**^« 
1-S/ 


.*     ,Ja:'3 


-  -     A 


RARE  FORMS  OF  GOUT  AND  RHEUMATISM. 


■-^(5».-.- 


Mr.  PRE8lDENT*;it»D  Gentlemen:  This  I  consider  "a 
red-lettii  day  "  in  my  professional  life's  work,  and  more  par- 
ticul^i%.firom  the  very  fact  of  having  received  so  generous 
an  iiiirkeition,  thtoligh  the  secretary  of  your  Association,  to 
read  %J^er  op  this  auspicious  occasion.  We  Canadians,  as 
a  wh^,  delight  in  noting  the  advance  of  our  Ainerican 
neighljjours  in  almost  every  line  of  thought  in  medical  and 
surgicftl  science.  The  assembled  wisdom  of  this  Association 
from  tfhe  state  of  New  York,  almost  a  kingdom  in  itself,  is 
only  an.  ipdex  to  the  intellectual  power  to-day  at  work  in 
almost  evfery  state  of  your  prosperous  Republic.  How  grat- 
ifying^ it  must  be  to  con  over  such  names  as  Rush,  Mott, 
McDowell,  Sims,  Gross,  Pancoast,  Flint,  Sayer,  Thomas, 
Emmett,  DaCosta,  Bowditch,  Godell,  Pepper,  Weir-Mitchell, 
Bull,  McBurney,  and  a  host  of  others,  equally  great  but  too 
numerous  to  mention,  who  by  their  skill  and  ability  have 
added  lustre  to  the  name  of  America.  To-day  I  propose 
offering  some  observations  on  rare  forms  of  gout  and  rheu- 
matism, conditions  not  by  any  means  frequent,  as  to  their 
occurrence. 

Cass  I. — ^Pneumonic  Gout. — The  following  brief  notes  are  of  a  pneu- 
monic form  of  gout,  associated  with  slight  hepatic  complication. 
H.  v.,  seventy-eight  years  of  age;  stout  habit  of  body;  not  plethoric, 
but  generally  vigourous,  and  accustomed  to  long  hours  of  arduous  offi- 
cial duty;  cannot  trace  gout  to  his  ancestors,  and  always  lived  well  and 
liberally.  February  10, 1893,  suddenly  seized  with  acute  pain  in  the  right 
sidd  of  chest,  opposite  the  middle  lobe  of  lung,  with  general  malaise 
and  rather  severe  cough;  no  excessive  flushes  in  the  cheeks;  the  breath- 
ing was  somewhat  humed,  about  thirty  per  minute;  temperature,  101.5^ 
to  103°  F.,  and  the  pulse  ranged  from  100  to  114.    The  cough,  after  the 


I 


s^ 


first  day,  was  associated  with  the  expectoration  of  a  thick,  tenacious^ 
and  rusty-coloured  mucus,  not  uniform,  however,  in  its  character,  but 
somewhat  patchy  as  to  the  distribution  of  the  blood  through  the  tough 
sputum.  The  left  side  moved  more  freely  during  the  respiratory  process 
than  the  right,  and  over  and  about  the  seat  of  pain  in  the  right  side 
there  was  an  evident  area  of  dulness  on  percussion,  and  yet  the  breath 
sounds  were  heard  with  a  degree  of  almost  unexpected  clearness,  with 
an  occasional  slight  mucous  rfile.  The  posterior  aspect  of  ^hp  ^iflbt 
lung  held  its  ground,  kept  moderately  clear,  and  in  fact  th&jpillln^Ptd' 
trouble  was  chiefly  confined  to  the  lateral  and  anterior  a^lpfc,iiniOdle 
lobe,  right  lung.  Throughout,  the  sputa  presented  an  miuiually  tena- 
cious character,  and  up  to  February  21  exhibited  a  patcliy,  rusty,  and 
most  peculiar  appearance,  after  which  date  it  became  clear,  but  retained 
the  sticky,  glutinous  peculiarity  up  to  February  27,  when  it  fij^sided. 
During  the  entire  illness  the  pain  in  the  side  was  not  of  the  usiiq^  pleu- 
ritic type,  but  more  of  a  burning,  throbbing,  aching,  and  piercing  pain^ 
and  out  of  all  proportion  to  the  ordinary  defined  pulmonic  condition. 
From  his  well-known  gouty  diathesis,  I  was  led  to  believe  the  attack 
was  really  one  gouty  in  character,  and  informed  the  friends  that  metas- 
tasis to  the  feet  of  the  lung  condition  was  not  unlikely.  On  February 
22,  both  feet  became  very  painful  and  swollen, — a  condition  of  system 
(as  to  his  feet)  he  had  experienced  several  times  during  the  past  ten 
years.  Almost  immediately  the  lung  improved  in  every  particular, 
which  quite  settled  the  point  as  to  the  gouty  character  of  this  attack  in 
the  hmg  tissue  as  a  primary  development.  Throughout,  the  usual  course 
of  treatment  was  adopted,  with  the  free  use  of  elixir  salicylate  of  lithia, 
and  lithia  water  as  well.  During  the  entire  attack  I  saw  no  special  indi- 
cations of  hepatic  trouble,  beyond  a  degree  of  uneasiness  about  the  liver 
generally.  Four  years  ago  he  had  a  well  defined  attack  of  jaundice, 
unattended  by  anatomical  lesion  to  account  for  its  development;  it  was 
of  short  duration,  and  passed  off  quickly. 

Case  II. — Perityphlitic  Gout. — Tlie  same  individual  whose  case  I 
have  just  cited  was  the  subject  of  the  following  data:  September  10, 
1892,  aged  seventy-seven  years.  Almost  up  to  the  present  attack  had 
been  enjoyi'jg  apparently  good  health ;  retired  to  bed  this  saine  evening, 
and  in  the  middle  of  the  night  was  suddenly  seized  with  a  severe  pain 
in  and  about  the  region  of  the  appendix  vermiformis,  attended  with  a 
sensation  of  throbbing,  together  with  a  degree  of  tension  in  this  partic- 
ular region,  which  radiated  more  or  less  over  the  entire  abdominal  walls ; 
considerable  heat  of  skin,  with  a  degree  of  restlessness,  general  febrile 
disturbance,  and  a  sense  of  uneasiness  about  the  stomach,  with  occasional 
vomiting.  Temperature,  102°  F.;  pulse,  116,  full  and  regular.  The  pain 
aoid  sensibility  of  the  abdominal  wall,  chiefly  over  the  ileo-caecal  region. 
The  bowels  were  constipated  and  the  tongue  moderately  coated  with 
a  moist  white  fur,  pointing  to  evident  gastric  derangement  for  a  taw 
days.  Ejiowing  the  gouty  history  of  this  patient  for  some  years,  although 
not  of  an  hereditary  type,  I  suspected,  from  the  character  of  the  pain, 
boring  and  gnawing,  such  as  I  had  observed  more  than  once  in  his  feet, 


4 


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i: 


that  it  might  prove  a  case  of  gout,  of  which  there  were  well  defined 
results,  such  as  tissue  thickening  about  the  tarsus  and  heels  of  both  feet, 
owing  to  the  deposition  of  gouty  material  during  past  years.  The  fin- 
gers in  both  hands  showed  also  evidences  of  disturbed  chemistry  in  the 
system,  resulting  in  gouty  thickening  in  and  about  various  joints.  The 
bowels,  though  at  once  relieved  by  an  enema,  still  continued  painful. 
Linseed  poultices  were  freely  applied,  sprinkled  with  chloroform  lin- 
)infnt,t|aid  tablets  of  sulphate  of  morphia  freely  administered,  to  relieve 
tho  intente  suffering,  which  was  so  acute  as  to  almost  prohibit  the  most 
modeiiilir  bed-clothing.  Salicylate  of  lithia  and  lithia  water  were  freely 
given,  as  soon  as  Admissible,  and  the  bowels  were  frequently  washed  out 
with  warm  water,  which  almost  played  the  part  of  an  internal  poultice. 
The  pulse  and  temperature  continued  high  for  fully  five  days,  when  both 
gradually  lessened  in  intensity,  and  about  the  sixth  day  pain  was  com- 
plained of  in  both  feet,  particularly  about  the  toes,  but  not  by  any 
means  as  severe  as  in  the  marked  metastasis  after  the  attack  of  pneu- 
monic gout. 

At  this  date  there  was  a  marked  amelioration  in  the  entire  character 
of  the  symptoms,  the  abdomen  became  more  flaccid  and  much  less  pain- 
ful on  pressure,  and  the  decidedly  caky  area  in  the  ileo-caecal  region 
gradually  parted  with  its  suspicious  indications.  McBurney's  appendix 
point  was  for  days  an  interesting ^nd  instructive  lookout,  until  rendered 
less  attractive  by  the  evident  outcome  of  metastatic  gouty  action.  Un- 
doubtedly there  was  well  marked  and  circumscribed  induration  in  the 
ileo-caecal  area.  The  precise  condition  or  character  of  this  induration 
was  difficult  to  define,  and  yet  the  rapid  change  consequent  on  meta- 
static action  pointed  to  gouty  deposition  in  or  about  the  region  of  the 
appendix,  so  peculiar  and  transitory  in  its  manifestations.  At  the  end 
of  three  weeks  an  excellent  "ecovery  was  made,  anr'  ince  that  date  there 
has  been  no  recurrence  of  intestinal  trouble. 

Case  III. — Eheumatic  Pebityphlitis.— Miss  T.,  twelve  years  of 
age,  vigourous  and  robust  habit  of  body,  conformation  regular,  and 
organs,  as  a  whole,  normal  prior  to  the  present  attack.  Of  a  highly  ner- 
vous temperament,  but  usually  enjoyed  excellent  health  and  spirits. 
June  1,  1893,  complained  of  pain  and  sense  of  uneasiness  in  her  feet, 
with  a  general  feeling  of  systemic  irritability.  June  3,  was  suddenly 
seized  with  severe  pain  in  the  bowels,  but  more  particularly  in  and 


about  the  ileo-caecal  region,  where  tenderness  on  pressure  was  most 
marked.  Fully  two  days  prior  to  June  1,  a  sense  of  heat  and  feverish- 
ness  was  experienced,  and  prior  to  being  under  my  charge.  Temper- 
ature, 102.5°  F.,  and  pulse,  120.  The  bowels  were  at  once  washed  out  by 
a  warm-water  enema,  which  afforded  much  relief.  Hot  linseed  poul- 
tices applied,  and  placed  on  milk  diet  and  an  aconite  mixture.  From 
June  2  to  8  the  pain  experienced  over  the  bowels  was  very  considerable, 
and  the  tenderness  so  severe  that  coughing  or  stretching  of  the  legs 
increased  the  pain  in  a  most  marked  manner.  Turpentine  enemata  also 
afforded  considerable  relief.  June  4,  there  was  a  decided  hardness 
•on  moderate  pressure  over  the  ileo-caecal  region,  which  gave  one  the 


I  \  '<Mi 


rmw""'^ 


,•■*;., 


ImpreHsion  that  aome  tissue  change  had  taken  place,  and  the  fact  that' 
rigidity  in  tlie  abdominal  walls  was  more  marked  on  the  affected  side 
than  on  the  other  led  me  to  view  the  condition  with  a  degree  of  suspi- 
cion, although  the  actual  position  of  hardn'^is  was  a  little  lower  down 
than  McBurney's  point.    For  fully  three  days  the  temperature  was  over 
102^  F.,  on  wliich  account  suppuration  would  not  be  an  unlikely  result. 
June  7,  the  right  shoulder,  elbow,  and  wrist  joints  exhibited  well  defined 
symptoms  of  acute  articular  rheumatism,  these  parts  being  |P>>infi^||^v  ,: 
pressure    swollen,  and  moved  with  difficulty.    Just  in  prq^Artiop^m''*^'^  ^* 
these  almost  outside  rheumatic  conditions  developed,  tffi  ipiominal^i  ' 
symptoms  actually  lessened  in  intensity,  and  on  the  lOJh  ^&%tiUre  feat- 
ures of  the  case  evidenced  a  marked  change  for  the  better,  no  relapse 
being  expeilenced  whatever.  .       "^g^     ,., 


The  question  very  naturally  arises,  What  was  the  attack, 
and  how  developed  ?  True,  the  recognition  of  appendicitis 
is  not  all  that  is  needed. 

In  this  case,  almost  from  the  first,  there  was  a  localised 
pain,  associated  with  tenderness  over  the  region  of  the  right 
iliac  fossa  and  ascending  colon,  with  well  defined  swelling, 
and  for  days  the  pain  was  so  severe  that  it  was  increased  at 
once  by  coughing  or  deep  inspiration,  and  the  almost  con- 
stant desire  was  to  elevate  both  knees  to  relieve  suffering. 
For  daj's,  also,  there  was  entire  inability  to  take  nourish- 
ment, owing  to  attacks  of  vomiting.  The  bowels  were  fre- 
quently injected  with  warm  linseed  tea,  wbich  afforded  a 
degree  of  nourishment  as  well  as  a  clearing  of  the  contents 
from  the  canal. 

In  this  case  I  concluded  there  was  lodgment  of  undigested 
material  in  the  caecum,  and  most  likely  induced  by  inability 
to  assimilate  the  food,  owing  to  deflected  nerve-power  from 
over-mental  strain,  as  is  frequently  the  case  in  our  schools 
and  universities  at  the  present  day.  In  the  ordinary  avoca- 
tions of  'a  we  can  trace  the  operation  of  like  results,  inter- 
fering seriously  with  the  very  principles  of  sanguinification 
and  blood  change. 

The  »iext  question  is.  How  is  rheumatism  associated  with 
perityphlitis?  True,  the  essential  cause  of  rheumatism  is^ 
still  a  doubted  point.  Errors  in  diet,  as  an  aetiological  factor, 
have  much  to  do  with  the  production  of  both  gout  and  rheu- 


•    » 


.«*■ 


matism,  and  such  strengthen  the  metabolic  theory,  that 
rheumatism  depends  on  a  morbific  material  produced  within 
the  system,  the  result  of  defective  processes  of  assimilation. 
True,  Prout,  Latham,  Richardson,  Mitchell,  and  Dr.  William 
H.  Porter,  of  New  York,  have  thrown  much  light  on  the 
subject  of  rheumatism,  and  certainly  the  present  case  points 
'  W^hejiBttatic  complication  as  the  outcome  of  defective  assim- 
♦  ilation^s^i'  important  factor  in  its  production.  Thus  the 
chemical  laboratory  of  the  human  system  becomes  disturbed, 
resulting  in  false  produots,  enabling  us  to  establish  a  con- 
necting link  between  even  peritjrphlitis  and  rheumatism.  In 
the  structure  of  the  intestinal  walls  there  is  undoubtedly  a 
.  large  amount  of  fibrous  tissue,  just  as  in  the  fascia  and  ten- 
dons of  the  joints,  and  it  is  reasonable  to  suppose  that  these 
structures  should  be  influenced  in  the  same  manner;  and 
assuming  that  the  case  under  consideration  was  even  quasi- 
rheumatic  in  its  character,  it  affords  one  more  illustration  as 
to  the  importance  of  giving  due  consideration  to  the  line  of 
action  embraced  in  medical  and  surgical  treatment  under 
like  circumstances. 

In  a  recent  paper  by  A.  Haig,  M.  A.,  M.  D.,  Metropolitan 
hospital,  London,  on  gout  of  the  intestines,  he  states,  that 
his  chemical  and  experimental  experience  has  led  him  to  be- 
lieve that  "  a  very  large  number  of  cases  of  colic,  enteralgid, 
and  enteritis,  and  cases  which  are  clinically  indistinguishable 
from  typhlitis,  are  neither  more  nor  less  than  a  gout  of  the 
walls  of  the  intestinal  tube,  or  a  rheumatism,"  as  has  just 
been  defined.  In  Canada,  as  a  whole,  gout  is  almost  an  un- 
known quantity,  except  in  occasional  cases  of  an  hereditary 
type.  Our  people,  in  the  midst  of  life's  pursuits,  live  in  a 
moderate  way,  which  contributes  greatly  to  the  promotion 
of  health.  On  the  other  hand,  rheumatism  is  of  frequent 
occurrence.  The  coldness  of  our  winter  climate,  the  occa- 
sional absence  of  flannel,  and  excessive  exposure  contribute 
to  develop  rheumatism.  After  noting  the  life-history  of  many 
thousands  of  our  '*  lumbermen,"  I  have  been  amazed  at  the 


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few  attacked  by  rheumatism.  Bread,  pork,  and  strong  tea 
constitute  their  chief  articles  of  diet,  and  the  general  experi- 
ence is,  that  the  tea  enables  them  to  digest  the  pork  with 
remarkable  comfort;  and  certainly,  after  a  hard  winter's 
work,  they  return  home  well  nourished  and  healthy  in  every 
particular.  '•    "  *    - 

Thej'^  facta  point  to  simplicity  as  to  diet.  Our  ^<^^ 
frequently  attained  the  age  of  "  three  score  and  1|[9^*  nour^ 
ished  by  grain  ground  between  two  ^aoikfi.  ■  As  a  rulei,  the 
people  of  the  present  generatioi4HvQ'''rDO  fast,  resulting  in 
mental  strain  anu  the  absence  of  simplicity.  With  greater 
attention  to  diet,  which  should  be  simple  in  its  character,  in 
conformity  with  the  normal  functions  of  the  alimentary 
canal,  and  the  avoidance  of  alcoholic  beverages  as  a  whole,  I 
feel  confident  perityphlitic  and  appendix  troubles,  even 
unconnected  with  gout  and  rheumatism,  would  become  less 
troublesome  factors  in  the  line  of  disease.  To  avert  various 
irregularities  in  the  alimentary  canal,  which,  if  neglected, 
will  undoubtedly  lead  to  tr  uble  in  time,  is  as  important  as 
subsequent  treatment,  wheu  the  stage  is  passed  in  which  the 
efforts  of  nature  are  powerful  to  afford  relief.  What  active 
agent  in  the  system  is  more  frequently  tampered  with  than 
gastric  juice,  which  requir?«  a  normal  temperature  to  per- 
form its  part  in  the  economy?  Ice-water  at  the  commence- 
ment, and  ice-cream  at  the  end,  of  a  meal,  may  be  fashionable, 
but  certainly  not  life  preserving.  Unassimilated  food  makes 
its  way  to  parts  not  designed  by  nature  to  transform  and 
absorb.  As  the  result,  how  frequently,  on  percussion,  we 
find  extensive  portions  of  bowel  ballooned  by  abnormal 
efforts  to  accomplish  the  digestive  process.  Such  conditions 
result  from  irregularities  in  living.  No  portion  of  the  ali- 
mentary canal  is  more  liable  to  diseased  manifestations  than 
in  and  about  the  appendix,  which  is  a  species  of  loop  line  to 
the  digestive  tract. 

Insurance  associations  cannot  note  too  carefully  the  proba- 
bilities of  life  in  this  connection.    There  is  still  much  to  be 


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accomplished,  and  let  our  medical  education  be  so  directed 
as  to  bring  about  simplicity  in  living,  as  near  as  possible,  to 
the  normal  functions  of  our  organs,  and  our  generation  will 
be  greatly  benefited.  % 


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